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New York expands Essential Plan health insurance: What is the new income cap?

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  • Staff Report 

Governor Kathy Hochul announced an expansion of the Essential Plan, New York’s affordable health insurance option under the Affordable Care Act, set to significantly lower costs for residents. Starting April, eligibility for the plan will extend to individuals earning up to 250% of the federal poverty level, increasing the income cap from $30,000 to $37,650. This expansion, approved by federal regulators for five years, is anticipated to save New Yorkers an average of $4,700 annually compared to standard Qualified Health Plans.

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The Essential Plan, catering to over 1 million low-income New Yorkers, offers comprehensive health benefits with no monthly premiums, no deductible, and minimal cost-sharing. This strategic move will make healthcare more accessible, particularly benefiting nearly 70,000 residents currently enrolled in higher-cost health plans and providing a lifeline for 12,000 DACA recipients and approximately 20,500 uninsured individuals.

With healthcare challenges such as long wait times and overcrowded ERs persisting, the Essential Plan’s expansion is a timely intervention. For individuals earning between $22,591 and $37,650, cost-sharing measures include affordable rates for primary care and specialist visits, inpatient stays, emergency room visits, urgent care, and prescriptions. This initiative underscores New York’s commitment to enhancing healthcare accessibility and affordability, further details of which can be found on the New York State of Health website.